Provider Demographics
NPI:1730115833
Name:EXLEY, STEPHANIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:EXLEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1193 WILLOW GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08343-4534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:649 N BROAD ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1621
Practice Address - Country:US
Practice Address - Phone:856-845-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00260500213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8489106Medicaid
NJ048752U6FMedicare PIN
NJU85502Medicare UPIN
NJ048752VU7Medicare PIN